NCMHCE Case Study Walkthrough | Marcus Case Using the C.L.I.N.I.C.A.L. Method (2025 Exam Prep)
Hello everyone. Welcome back to my channel. If you’re new here, my name is Lordis. I help future counselors like you pass the NCHE with purpose. Today, we are using the clinical method to break down another case together. This one is all about Marcus, who is a 19-year-old college student dealing with academic pressure and emotional exhaustion. If you haven’t already seen the clinical method explained or practiced with Jasmine case, pause and go watch that first video first. Otherwise, if you have, if you ready to dive in, get ready. We’re going to go step by step. I’ve already highlighted everything so I can talk you through what matters and why. And whether you’re watching at home or you’re listening on the go, you will be able to follow along. And remember, the first five questions we’ll go over together. If you want to test yourself and finish the full case with all 12 questions, you can go grab volume one link, which is in the description, or visit my link tree anytime to get the link from my gum rope. All right, so we’re going to quickly go over what clinical stands for. is just a acronym that I created to break down narratives in a structured in a structured effective way. Okay. C is for complaint. What brings the client to therapy? L is for level of functioning. How are they doing socially, emotionally at work? I is for impact. How is the problem affecting them across major life areas? N is for needs, what they require for safety, sta stabilization, and support. The second I is for interventions. What’s been tried or should be introduced for the client. C is for coping skills. What strategies they’re using or lacking. A is for assessment, the clinical impression or what we suspect diagnostically. And finally, the L is for their life goals, what they hope for long term. Now, keep this framework in mind as we read Marcus case and we start applying the colors and the breakdowns because we’re going to use this exact method in real time. Quick heads up before we jump in. I already did the highlights on Marus’s case. Um, I’ll walk you through each one step by step using the clinical method. They are preh highlighted since I cannot record live and mark at the same time. But if you’re watching and you’re focused, feel free to pause, read, take notes, and follow along like we’re doing this live together. I’m going to read out loud and you go ahead and pause and read. Marcus is 29, male. His gender identity is male. His sex is male. His sexuality is heterosexual. His ethnicity is African-Amean. His relationship status is single. His counseling setting is outpatient counseling center. He’s getting individual therapy. His provisional diagnosis is major depressive disorder, moderate. Marcus presents for individual counseling following recent personal loss. He reports persistent sadness, feeling numb and disconnected, oversleeping and withdrawing from friends and family. Marcus shared that he has difficulty difficulty getting out of bed most days and has recently been terminated from his job for excessive absences. He shares that he feels worthless and questions whether life will ever improve. He reveals his fiance ended their engagement two months ago after he discovered she had been involved romantically with his best friend. He describes feelings of betrayal, shame, and hopelessness. He appears disheveled with poor hygiene and an unshaven appearance. He is oriented to a person, place, and time. His speech is slow and soft with long pauses before responding. His affect is flat and his mood is described as empty. Thought processes are logical but slow. Marcus denies active suicidal intent but expresses passive suicidal ideiation, stating, “Sometimes I wonder if it’s worth waking up anymore.” No hallucilations or delusions are observed. Judgment and insight appear moderate moderately impaired by his depressive symptoms. Marcus reports no prior history of mental health treatment. He describes growing up in a conflict household with minimal emotional support. He completed two years of college before withdrawing due to financial difficulties. His social support system has disinished significantly following the breakup. He identifies one cousin he occasionally speaks to but says mostly it’s just me now. Session two, he returns to therapy after 2 weeks. He report that he continues to struggle with energy and motivation. Marcus discloses he recently emailed the therapist at 3:00 a.m. saying, “I am not planning anything right now, but sometimes I think about not being here anymore.” Marcus expresses embarrassment about the email, stating he just felt overwhelmed in the moment. In session, he admits that he continues to isolate himself and reports increased irrability and difficulty sleeping. He denies current suicidal plan or intent, but acknowledges feeling stuck. Now, let’s starts with C. C is the presenting problem. What brought Marcus to therapy? As you can see with the red highlight, Marcus Lewis presents for individual count counseling because of following personal loss. He reveals his ex- fiance ended their engagement. He has persistent sadness. He feels numb and disconnected. He’s oversleeping and withdrawing from friends and family. He was terminated terminated from his job for excessive absences. He feels worthless and questions whether life will ever improve. That right there, what you see highlighted in red and what you read also, that is a classic explanation of depressive symptoms and emotional suffering following a betrayal and breakup. This is the core complaint for L level of functioning. Let’s talk about Marcus current level of functioning in his daily life. He has difficulty getting out of bed most days. He was terminated from his job. He withdrew from friends and family. His mental ecstatics exam um says that he is disheveled, has poor hygiene and unshaven appearance. Those are key indicators of significant impairments in occupational and his social domain and clearly is moderate to severe dysfunction. He have depression where he can’t even get out of bed most days. So that right there is the L level of functioning in Marcus’s case. Now let’s look at the impact which is yellow. We look at how this problem is affecting different parts of his life. His fiance ended their engagement after he discovered her affair with his best friend. So Marcus feel betrayed, ashamed and hopeless. Mind you, these are his exact word. He describes feelings of betrayal, shameless, and hopelessness. His social support has disinished. He says in his psychosocial that he only speaks to one cousin but is mostly just me now. He struggles with energy and motivation. He has increased irritability and difficulty sleeping. That impact is emotional, social and relational. So that let us know that Marcus has lost trust withdrawn from others and he is isolating himself. That is the impact of what he’s experiencing right now. Now, let’s talk about his needs. What does Marcus need for stabilization right now? You’re the therapist. Put on your therapist hat. What do you think Marcus need for stabilization? If you were paying attention and you were reading carefully, you would highlight and see that he has passive suicidal ideiations. He says he sometimes wonder if it’s worth waking up anymore. In addition, he has poor insight and judgment. He’s impaired by his depressive symptoms. He’s embarrassed after emailing the the therapist at 3:00 a.m. to express his distress. That means he needs a what? Come on, therapist. You got it. If you said he needs a comprehensive risk assessment, give yourself a pat on the back. That is correct. He needs a comprehensive risk assessment. Emotionally, he does not feel safe. So, it is your responsibility counselor. It is your responsibility therapist to create a safety plan and give him some psycho education about his depressive symptoms. Now, let’s go over the interventions. What are some appropriate intervention based on where Marcus is now in the current moment? He has suicidal ideiation therapist counselor. Yes, you. What do you need exactly? Risk assessment. You also have to build therapeutic rapport. Validate his feelings of loss. Validate his feelings of betrayal and hopelessness. Begin planning coping strategies with him gradually. Now let’s talk about coping skills. Where is he with his coping skills? Do he have any coping skills? Is he using any coping skills? You should have noticed what we have highlighted is he isolates, oversleeps, and he avoid others. No healthy coping mechanisms. noted he doesn’t have any friends, no hobbies or treatment history. So this tells you therapists that we have to teach and reinforce new coping strategies in therapy. You also have to start small. Now for assessment, what are we clinically seeing here in terms of symptoms and possible diagnosis? H ding ding ding ding. Go to your mental status exam. He has a flat aic, slow speech. He feel hopeless. He cannot sleep. He has insomnia. Although he have no hallucinations or delusions, he have moderate insight and impairment. Therapist, come on, work with me now. That is telling you all his symptoms support a textbook classic case of major depressive disorder. Moderate to severe with passive suicidal suicidality with no signs of psychosis. So that right there supports his provisional diagnosis. Now, for his life goals, we didn’t hear Marcus state explicitly his long-term goals, but he desires to feel better and to stop isolating. Those were implied on the next page where he said when he spoke to the therapist about the email. So, you can see that in that block of text, he’s showing up to therapy and emailing the therapist, which shows some hope and engagement, even if it’s minimal. So, right now, your your your therapist’s hat should be ringing. He needs emotional stabilization, psycho education on grief, and a treatment space that allows him to process loss without judgment. That baby needs support. And this is where we come in. We have to give him support. And this is why the ACA ACA wants to test if we can clinically assess a case and know what the client needs. If we can be ethical, if we can plan a treatment plan, if we can assess, if we can see what risk do they have. Now, we’re gonna read the questions and I’m gonna give you the correct responses, but I’mma tell you why. Okay. Number one, what is the counselor’s primary goal during the initial intake session with Marcus? A, immediately assign intensive homework activities to boost motivation. B, build therapeutic rapport and assess the se severity of depressive symptoms. C, encourage Marcus to reapply for new jobs to distract from sadness. D. refer Marcus for impatient hospitalization due to unemployment. Okay, we got to keep it real. Let’s keep it all the way real. Marcus is vulnerable right now. He’s barely functioning. He just got betrayed and he’s questioning whether life will get better. This is not the time therapist. Don’t you ever assign homework in the first session. That’s that’s a no. You building rapport. So your job in the first session is to build rapport, establish trust and begin a thorough clinical assessment. That is why B is mostly the clinically sound option. Number two, which client statement strongly suggests or supports a diagnosis of major depressive disorder? A, I get so anxious around people sometime. B, I feel like I can’t even get out of bed most days. C, sometimes I drink too much when I get go out with friends. D, I like to stay busy by avoid thinking too much. The correct answer, let before we get into the correct answer, let’s just break down this question. This one, this question is about symptoms. The key phrase here is can’t get out of bed most days. That’s functional impairment. So if you ever read a case and someone can’t get out of bed all day, think functional impairment. So MDD is not just about sadness. It’s about how deeply it’s affecting your daytoday functioning. That’s why B, I cannot get out of bed most days clinically sound. Got it? Let’s continue with number three. What assessment tools will be most appropriate to administer based on market s symptoms? A. Beck depression inventory and Columbia suicide severity rating scales. D. General general generalized anxiety disorder seven item scale and PCL PCL5. B. Brown obsessive compulsive scale and cage. D. disorder questionnaire and Vanderbilt assessment scale. You remember when I said we need to know which assessment go with who, when, where, what, and how, which diagnoses go with which assessments. This is the part that you need. So I want you to think what are we trying to measure? Not only what are we trying to measure, what are we trying to measure in relation to this specific client. So let’s talk about Marcus. He presents with what? Depressive symptoms and passive suicidality. So the two key correct answer would be the BDI, the beg depression inventory. If you you if you get that wrong, I’mma be so upset. Every time you see depression and it’s major, always think BDI. Okay. Anyways, that gives us insight into the severity of the depression and the assessor, the CSSR, the Colombia severity scale assesses for suicidal risk. These two together is the gold standard combo for depression and suicide. Therefore, answer A is the correct answer. Now, let’s go on to number four. But before we do that, let’s take a pause. Let’s check in. you hanging in there? You okay? Let me know in the comments if I’m going too fast. Just Hey, I’m just trying to give it to you straight. So, just let me know. Trust me, I will not take offense. I’m trying to teach you. I want you to learn cuz I do not want you to make the same mistakes I made. Remember, four times is a charm. And I’m trying to get you to do it one time. And if you have to come back a second time, that’s okay. We going to do it till we get right. All right, question number four. From an ethical perspective, what is the counselor’s next best step after hearing Marcus express suicidal ideiation? A, ignore it unless unless he states a specific plan. B, complete a thorough risk assessment and document it. C, immediately call emergency service for a welfare check. D, terminate therapy services due to safety control concerns. You better not. You You better not circle answer A. You You bet not. Okay, listen. This is important because Marcus is not in immediate danger, but he’s at risk ethically and clinically. You need to assess, explore, and document. You do not jump to emergency services if there is no plan or intent. So, your safest bet is B because that’s the next professional step. This is all about providing ethical care and clinical judgment. Marcus has passive suicidal ideiation, which is serious. I don’t want you to think, oh, just because they have suicidal ideiation, it’s not serious. That is serious. However, it’s not to the extent where you call 911. Don’t be wasting our tax dollars now. Come on now. You know, we pay for 911 services, but let’s focus on the task at hand. The correct response is to assess thoroughly and document clearly. That means answer B is correct. Calling emergency services is premature, especially without assessing his risk factor. Okay, last one. What is the most clinically appropriate response to Marcus overnight email expressing passive suicidality? Okay. A. Immediately call Marcus and involve law enforcement. B. Address the email with Marcus during the next scheduled session assessing risk thoroughly. C. Ignore the email because no plan was disclosed. D. Email Marcus back immediately providing crisis hotlight hotline number only. This one is tricky and this is how this what trip me up when I took the um test some time ago because he emailed at 3:30 in the morning, right? But he did not indicate an active plan or intent. You don’t want to underreact, but you also don’t want to overreact. So the best response will be one that’s bound and solid in ethics. So the ethic and clinically sound response is to bring it up in the next session and assess risk thoroughly just like the answer B says. Okay, I hope that was helpful. I really hope I was able to break it down for you to understand. Just a little disclaimer. I know it looks like I chose answer B for every for almost every single question so far, but promise I promise you I just listen to me. That’s just a coincidence on a real exam. Don’t let the patterns like that psych you out. Always go with clinically clinical reasoning over guessing based on letters. We don’t panic just because the same letter shows up. No, we don’t do that. we focus on the response that makes the most clinical sense. Okay. Now, our next video, we’re going to go over Sasha Sasha’s case, um, which is our case three. She is a pansexual white transgender client presenting with borderline personality disorder and hypomomanic features. So, this one is is a little is a little bit more intense. So, if you’re ready to stretch your skills and apply the clitical method to a more complex presentation, you don’t want to miss this one. But if you can’t wait or if you’re in your flow, go ahead and grab volume one now. It includes Sasha full case and more narratives designed to help you build confidence and strategies. As always, and I mean what I say, if you get stuck or you just want to connect, drop a comment below, email me. I got you. And please don’t forget to subscribe and tap the bell so you know when the next narrative breakdown drops. Let’s keep growing together. Every Sunday, 700 p.m. Eastern Standard Time, I will have a new narrative for us to go over and break down. Thanks so much for watching. Whether you’re just starting out or brushing up on your skills, I’m rooting for you. Volume one is live and ready whenever you are. The description is in the link is in the description. And if you ever have any questions or need clarity, don’t hesitate to reach out. You got this. See you soon.
00:00 – Intro
00:45 – Marcus Client Snapshot
01:30 – Applying the C.L.I.N.I.C.A.L. Method
06:00 – Practice Questions Breakdown
09:00 – Key Takeaways + How to Study Smarter
Are you preparing for the NCMHCE in 2025 and struggling to break down narratives like a clinician? In this video, we walk through Marcus’s case study using my C.L.I.N.I.C.A.L. method — a structured, easy-to-follow framework designed to help you think critically, identify key diagnostic and treatment factors, and pass with purpose.
✅ Perfect for future LMHCs, mental health counseling students, and exam retakers
🧠 Learn how to spot the presenting problem, risk factors, and clinical red flags
📋 Get familiar with what the NCMHCE is really testing — and how to organize your answers like a pro
Whether you’re struggling with case conceptualization, treatment planning, or clinical judgment — this practice case will give you clarity and confidence.
📥 Want to download this case and try it on your own?
🎓 Grab Volume 1 (Pay What You Can): [Insert Gumroad Link]
📧 Questions or tutoring inquiries? Email me at: [Your Email]
NCMHCE 2025, NCMHCE practice case, LMHC exam prep, mental health counseling exam, C.L.I.N.I.C.A.L. method, Marcus case, clinical reasoning, counseling case study, narrative breakdown NCMHCE, mental health counselor exam, how to pass the NCMHCE, BiblePrep by Lourdes, test prep for therapists, clinical exam tips, 2025 NCMHCE walkthrough